COLORADO UNIFORM CONSUMER CREDIT CODE
2019 RENT-TO-OWN INITIAL NOTIFICATION FORM
WEBSITE: WWW.COAG.GOV/UCCC EMAIL: UCCC@COAG.GOV
TELEPHONE: (720) 508-6012
YOU MUST COMPLETE ALL SECTIONS AND FORMS. IF A SECTION DOES NOT APPLY, PLEASE WRITE N/A.
ENCLOSE CHECK PAYMENT WITH SUBMISSION.
RETURN TO:
COLORADO DEPARTMENT OF LAW
UNIFORM CONSUMER CREDIT CODE
RALPH L. CARR COLORADO JUDICIAL CENTER
1300 BROADWAY, 6TH FLOOR
DENVER, CO 80203
MAKE CHECKS PAYABLE TO:
COLORADO UNIFORM CONSUMER CREDIT CODE
OR COLORADO UCCC
COMPLETE THE FOLLOWING:
1. LEGAL NAME:
2. ALL TRADE NAMES IN WHICH BUSINESS IS TRANSACTED:
3. PHYSICAL ADDRESS OF INDIVIDUAL OFFICE/STORE:
4. DATE IN WHICH RENTAL PURCHASE AGREEMENTS COMMENCED AT ABOVE INDIVIDUAL OFFICE/STORE:
5. PHYSICAL ADDRESS OF PRINCIPAL OFFICE (MABE BE OUTSIDE OF COLORADO):
6. ARE RENTAL PURCHASE AGREEMENTS MADE IN A PLACE OTHER THAN AT AN OFFICE/STORE IN COLORADO?
(CIRCLE ONE) YES
OR NO IF YES, HOW? ___ MAIL ___ INTERNET ___ OTHER ___________________________
7. NAME & ADDRESS OF COLORADO REGISTERED AGENT UPON WHOM SERVICE OF PROCESS MAY BE MADE:
FEE SCHEDULE
INITIAL NOTIFICATION FEE FOR THIS PHYSICAL LOCATION $50.00
THE UNDERSIGNED HEREBY FILES NOTIFICATION OF INTENT TO ENGAGE IN MAKING RENTAL PURCHASE AGREEMENTS
WITHIN THE STATE OF COLORADO.
I HEREBY VERIFY THAT THE INFORMATION STATED ABOVE AND THE AMOUNT PAID ARE TRUE AND CORRECT.
X_____________________________________________________
___________________
SIGNATURE OF OWNER/OFFICER/PARTNER
DATE
_____________________________________________________
___________________
___________________
PRINTED NAME OF OWNER/OFFICER/PARTNER
TELEPHONE NUMBER
EMAIL ADDRESS
MANDATORY INFORMATION FOR SOLE PROPRIETORS (NOT OPEN TO PUBLIC INSPECTION). THIS INFORMATION IS REQUIRED BY §§ 14-14-113 AND 24-31-107,
C.R.S. AND MAY BE USED TO REVOKE, SUSPEND, OR DENY LICENSES OR NOTIFICATIONS AS DETERMINED BY THE STATE CHILD SUPPORT ENFORCEMENT AGENCY
FOR NONCOMPLIANCE WITH SUPPORT ORDERS OR SUBPOENAS/WARRANTS RELATING TO PATERNITY AND CHILD SUPPORT.
ALSO INCLUDE A PHOTOCOPY OF YOUR DRIVER’S LICENSE, STATE IDENTIFICATION CARD, OR OTHER PHOTO IDENTIFICATION.
COMPLETE HOME ADDRESS: ___________________________________________________________________ ________ SSN: _______________________
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signature
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2019 CONTACT INFORMATION LIST
Colorado Uniform Consumer Credit Code
Please provide the following information and return with your notification form.
Company Name: _____________________________________________________________________
Contact Person for Notification Questions and General Mailings:
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Address: ___________________________________________________________________________
___________________________________________________________________________
Email Address: ____________________________ Phone Number: _________________________
Con
tact Person for Compliance Examinations: Same as Above:
___
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Address: ___________________________________________________________________________
___________________________________________________________________________
Email Address: ____________________________ Phone Number: _________________________
Contact Person for Consumer Complaints: Same as Above:
___
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Address: ___________________________________________________________________________
___________________________________________________________________________
Email Address: ____________________________ Phone Number: _________________________
2019 OWNERSHIP–COLLECTION ACTIVITY QUESTIONNAIRE
Colorado Uniform Consumer Credit Code
Please provide the following information and return with your notification form.
Company Name:
____________________________________________________________________________
Provide the names of the owners, stockholders of the corporation, or the members of the
limited liability company and the percentage of each owner’s, stockholder’s, or member’s
ownership interest. For corporations: If publicly traded, list all entities holding 10% or
more of the stock; If privately held, the number of shares must equal 100% of stock.
(Attach additional pages if necessary)
Nam
e % of Stock or Member Ownership
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Collection Activity
1. Provide the name and address of each collection agency, engaged by the notifier, to
collect defaulted Colorado consumer rent-to-own transactions.
(Attach additional pages if
necessary)
Name of Company Address
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
2. Provide the name and address of each debt buyer, to whom the notifier sold defaulted
Colorado consumer rent-to-own transactions.
(Attach additional pages if necessary)
Nam
e of Company Address
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________